GER, or Gastroesophageal Reflux, is very common in children with neurological impairments. In fact, is has been estimated that up to 75% of kids with neurological impairments experience reflux.

Luckily, there are a number of diet and lifestyle changes that can help to lessen the effects of GER.

Gastroesophageal reflux occurs when foods or liquids in the stomach reverse direction and go back into the esophagus, throat or mouth.

If you think of the mouth to throat to stomach pathway as a road, there is a gate between the throat and the stomach to keep traffic moving in one direction toward the stomach.

This “gate” is called the esophageal sphincter.

If the gate swings open rather than staying closed, food, liquid and stomach acid can all pass back into the throat – going the “wrong” way on this one-way street.

In kids with neurological impairments, the gate (esophageal sphincter) may be more likely to let food or drinks pass through when it is not supposed to.

In addition, long periods of lying down, scoliosis, increased pressure in the stomach and seizures can also make GER more likely in these kids.

Repeated reflux can cause inflammation of the esophagus, and may eventually lead to ulcer formation or strictures (a narrowing of the esophagus that can lead to more difficulties swallowing).

Most of us experience reflux at one time or another.

If you have ever burped after eating and experienced a burning sensation in your throat, it was probably caused by GER.

Children may not always be able to put into words the symptoms that they are experiencing.

The unpleasant sensations associated with GER may cause them to avoid foods, leading to reduced food intake.

Frequent spitting up or vomiting can also contribute to nutrient and energy losses, leading to difficulties in gaining or maintaining weight.

Since children cannot always communicate their symptoms (such as that “burning” feeling), it is important for parents and carers to be on the lookout for symptoms of GER.

Symptoms can include:

- Frequent regurgitation with or without vomiting

- Weight loss or poor weight gain

- Frequent pneumonia

- Irritability in infants

- Wheezing or cough

- Complaints of stomach pain

- Refusing to eat.

If your child does experience GER, foods that are likely to cause irritation should be avoided.

These typically include chocolate, spicy foods and any foods or drinks containing caffeine. Large, high-fat meals may also cause symptoms, and should be avoided if they do.

If your child uses bottle or tube-feedings, thickened formula may help reduce reflux.

Using concentrated formulas that have more calories in a smaller amount of liquid can be a helpful way to make sure that your child is getting enough calories.

Check with your physician or dietitian if you suspect a change in formula might be helpful.

Here are more tips to help manage GER symptoms.

For babies:

Adding rice cereal to formula may be helpful; check with your physician or dietitian.

If using a bottle to feed, keep the nipple filled with milk so that your baby doesn’t swallow too much air.

Swallowing air can cause excess burping, which may be accompanied by reflux.

Burp your baby occasionally throughout bottle- or breast-feeding.

Burping is less likely to cause reflux when baby’s stomach is only partially (rather than completely) full.

For children:

Offer your child snacks and small meals throughout the day, rather than just a few large meals.

Limit fried and fatty foods, chocolate, soda or other caffeinated drinks, citrus fruits and juice, tomato products, and peppermint.

If your child has any inflammation of his/her esophagus, acidic foods such as citrus and tomato products can cause further irritation and pain.

Offer the evening meal at least 3 hours before bedtime.

Encourage your child to stay upright, rather than lying down, for at least 30 minutes after eating.

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